title: Use of aldosterone antagonists at discharge after myocardial infarction: results from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get with the Guidelines (GWTG).
abstract: BACKGROUND
  Aldosterone antagonists (AldA) improve survival after myocardial infarction (MI) in patients with left ventricular systolic dysfunction (ejection fraction [EF] <40%) concomitant with either clinical heart failure (HF) or diabetes mellitus (DM). Although current American College of Cardiology/American Heart Association guidelines provide a class I recommendation for AldA therapy in such patients, how US practice reflects these recommendations is unclear.
  
  
  METHODS
  Using data from the National Cardiovascular Data Registry ACTION Registry-GWTG, we describe contemporary discharge AldA prescription patterns among 202,213 patients discharged after acute MI from 526 US sites participating in ACTION Registry-GWTG between January 2007 and March 2011.
  
  
  RESULTS
  Overall, 10.0% of patients were eligible for AldA without documented contraindication, with only 14.5% of eligible patients receiving AldA at discharge. Among the subset of AldA-eligible patients discharged on otherwise optimal medical therapy (68.9%), AldAs were prescribed to 16.1%. Aldosterone antagonist use was higher in patients with EF <40% and clinical HF with or without DM (17.7% and 16.6%, respectively), compared with patients with EF <40% and DM without clinical HF (7.8%, P < .001 for each). Fewer than 2% of participating centers used AldA in ≥50% of eligible patients.
  
  
  CONCLUSIONS
  Despite clinical outcome evidence and class I guideline recommendations, AldAs are underused in the United States, with only 1 in 7 eligible patients prescribed AldA at discharge after MI. This contrasts with high use of other evidence-based post-MI medications and identifies a specific gap in translation of evidence into clinical practice.
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Krishnasree K
authors.initials: KK
authors.lastname: Rao
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Enriquez
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Chen
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Sandeep R
authors.initials: SR
authors.lastname: Das
mesh_terms: D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010351:Patient Discharge; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000451:Mineralocorticoid Receptor Antagonists